Background: Hearing loss is prevalent and consequential but under-diagnosed and managed. The Medicare Annual Wellness Visit (AWV) health risk assessment elicits patient-reported hearing concerns but whether such information affects documentation, diagnosis, or referral is unknown.

Methods: We use 5 years of electronic medical record (EMR) data (2017-2022) for a sample of 13,776 older primary care patients. We identify the first (index) AWV indication of hearing concerns and existing and subsequent hearing loss EMR diagnoses (visit diagnoses or problem list diagnoses) and audiology referrals. For a 20% random sample of AWV notes (n = 474) we compared hearing loss EMR diagnoses to documentation of (1) hearing concerns, (2) hearing loss/aid use, and (3) referrals for hearing care.

Results: Of 3845 (27.9%) older adults who identified hearing concerns (mean age 79.1 years, 57% female, 75% white) 24% had an existing hearing diagnosis recorded. Among 474 patients with AWV clinical notes reviewed, 90 (19%) had an existing hearing loss diagnosis. Clinicians were more likely to document hearing concerns or hearing loss/aid use for those with (vs. without) an existing EMR diagnosis (50.6% vs. 35.9%, p = 0.01; 68.9% vs. 37.5%, p < 0.001, respectively). EMR diagnoses of hearing loss were recorded for no more than 40% of those with indicated hearing concerns. Among those without prior diagnosis 38 (9.9%) received a hearing care referral within 1 month. Subgroup analysis suggest greater likelihood of documenting hearing concerns for patients age 80+ (OR:1.51, 95% confidence interval [CI]: 1.03, 2.19) and decreased likelihood of documenting known hearing loss among patients with more chronic conditions (OR: 0.49, 95% CI: 0.27, 0.9), with no differences observed by race.

Conclusion: Documentation of hearing loss in EMR and AWV clinical notes is limited among older adults with subjective hearing concerns. Systematic support and incorporation of hearing into EMR and clinical notes may increase hearing loss visibility by care teams.

Keywords: Medicare; annual wellness visit; hearing.

© 2024 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.

背景： 听力损失普遍存在且后果严重，但其诊断和管理不足。Medicare年度健康访问（AWV）的健康风险评估会记录患者报告的听力问题，但这种信息是否会影响文档、诊断或转诊尚不清楚。

方法： 我们使用了2017-2022年五年期间的电子病历（EMR）数据，样本包括13,776名老年初级保健患者。我们确定第一次（索引）AWV记录的听力问题，并识别现有的和随后出现的听力损失EMR诊断（就诊诊断或问题列表中的诊断），以及听力学转诊情况。对于20%随机抽取的AWV笔记样本（n=474），我们将听力损失EMR诊断与以下内容进行了比较：(1) 听力问题记录，(2) 听力损失/助听器使用情况记录，和 (3) 转诊至听力护理。

结果： 在识别出听力问题的3845名（27.9%）老年人中（平均年龄79.1岁，女性占57%，白人占75%），已有记录的听力诊断比例为24%。在审查了临床笔记的474名患者中，90（19%）有已有的听力损失诊断。对于那些已有EMR诊断的患者，医生更可能记录听力问题或听力损失/助听器使用情况（分别为50.6% vs. 35.9%，p=0.01；68.9% vs. 37.5%，p

结论： 对于有主观听力问题的老年患者，其在EMR和AWV临床笔记中的听力损失记录有限。将听力问题系统地纳入EMR和临床笔记的支持和整合可能会增加护理团队对听力损失的关注度。

关键词： Medicare; 年度健康访问；听力

© 2024 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.